A new brief by the Urban Institute indicates that nearly two-thirds of adults (62 percent) who are covered by or have a Medicaid-enrolled family member are unaware that Medicaid renewals will be restarting in the future. Of those who had heard at least a little about the resumption of renewals, the largest source of information (34 percent) was from the media, including social media, followed by the state agency (30 percent), a health insurance company or plan (24 percent), a health care provider (18 percent), or somewhere else (6.5 percent). Just over half of those who learned about the upcoming change from state agencies or health plans received a notification of the need to renew coverage.
Among adults in families with a member who enrolled in Medicaid during or after March 2020, 56.5 percent had heard nothing at all about the resumption of renewals. While this is slightly better than the overall 62 percent who had heard nothing, this is a group who may have no experience with their state’s renewal requirements and may require more assistance.
How does this compare to other research of Medicaid enrollee awareness of renewals? Qualitative in-depth interviews with 49 enrollees conducted on behalf of CMS suggested that most enrollees are not concerned or wondering about reenrollment. But almost half of those indicated that their coverage had been renewed since the continuous coverage provision was enacted in March 2020.[i] Many respondents indicated they know it’s time to reenroll when their card no longer works at the doctor’s office. In my book, that is the worst possible scenario – awareness after coverage has been terminated.
The CMS research also focused on the best messages to use with consumers as the renewals start back up. For example, the findings indicate that messages should not refer to the public health emergency. It recommends that messages not mention that autorenewal might occur and not use vague timing such as “this year.” So, this makes communications tricky, right? What’s the best way to message that renewals are restarting without alarming people if their renewal isn’t scheduled for months? The CMS research suggests keeping it simple: “Check your mail – Medicaid will either send you a letter confirming your coverage is renewed or a renewal form you need to complete.”
It’s no secret that people need to hear messages multiple times before they take action. And the Urban Institute study points out that enrollee receive messages from a variety of sources. While the CMS research indicates appropriately that respondents look to the states for “official mail,” the Urban Institute study reflects the importance of messaging through multiple sources, including using the power of the media, Medicaid health plans, and health care providers. The CMS research also indicated that enrollees often rely on other social programs and health care providers for assistance with enrollment. Joint communication efforts with these organizations are likely to reinforce messages and notices coming directly from the state Medicaid agency.
The findings from focus groups conducted in February 2022, which were featured during our 10th Unwinding Webinar in September, provide additional insight on communicating about the unwinding. These findings conclude that associating the resumption of renewals with the public health emergency was not only confusing but it was particularly frightening terminology for Spanish-speakers. Focus group participants also confirmed that they see the state agency as the official information source but want to hear about renewal from other sources. To that end, Medicaid health plans, health care providers, navigators and assisters, and policy and advocacy organizations should all take steps to reinforce messages coming from the state and fill in gaps where the state may not be reaching enrollees.
It’s not surprising that a majority of enrollees are unaware of what lies ahead. Not all states maintained consistent communications with enrollees through the PHE. Additionally, experts have recommended staging key communications messages to coincide with current actions. Since we still don’t know when the continuous coverage protection will end, some states may be waiting to alert enrollees that the Medicaid rules and procedures are changing. Regardless of when communications about the resumption of renewals are initiated, it is clear there will be challenges. Clarity of messages and notices from state agencies; amplification and reinforcement of key messages by Medicaid plans, health care providers, and other stakeholders; and personalized follow-up explaining what action is required to maintain coverage at renewal are essential to avoiding loss of coverage due to procedural reasons.
[i] A number of states continued to use ex parte processes to automatically renew coverage during the PHE. Although states may not disenroll anyone during the PHE, CMS encouraged states to continue to process renewals to the extent possible.